Brigid McMaster is Clinical Nurse Coordinator for Out of Hours District Nursing at the Ayrshire Urgent Care Service based at Crosshouse Hospital in Kilmarnock and uses her wealth of experience to assess the need for change to services to meet the healthcare needs of people across Ayrshire.
I came into nursing opportunistically. I come from a family of teachers but it never appealed to me. One of my friends went into nursing, and she was so enthusiastic about it and I thought I would give it a go. I applied, I was accepted but I still didn’t really know what to expect. Then I went into my first placement on the wards and I thought instantly that it was great. I loved that it was about people. Never for one minute did I consider not continuing with it. I knew it was for me.
When I qualified I worked in high dependency medical for about nine years but it got to the stage where I wasn’t getting the same job satisfaction out of it and things were changing in the community setting, the balance of care was shifting. I applied for a post as a community staff nurse. It was such a good experience, I loved the fact you had to be a specialist generalist. The years I spent working in medical wards really helped as I had lots of experience. I then did the district nursing specialist qualification and until 2005 worked as a district nursing sister leading a small team of staff attached to a GP practice in South Ayrshire.
Thereafter I successfully applied for an Assistant Clinical Nurse Manager’s post. That was a real eye-opener as I realised at that point the diverse and complicated situations and problems encountered by staff in other teams, of which I was previously unaware.
I came into my current role through structure change across the health board. Since being in post, I have guided out of hours (OOH) staff through a change process to provide a more flexible service to patients across Ayrshire, and also to actively participate in an OOH Urgent Care Service / Hub in line with the Professor Sir Lewis Richie OOH Review Report.
I have had so many great opportunities through my nursing career, I’ve never had a plan but I can honestly say I have enjoyed everything I have ever done.
The Out of Hours District Nurse (OOH DN) team provides a support service to all the district nursing teams attached to GP practices during the day. Communication and appropriate information-sharing is key to ensuring a joined-up, seamless, 24/7 service, which has the patient at the centre of all care including care plans and decision-making.
As well as the operational day-to-day duties which ensure this happens, I provide support to staff with operational line management responsibilities as well as managing the OOH DN team budget. I make sure there is robust clinical supervision and support for all the OOH team across Ayrshire and ensure clinical governance standards are in place.
My main motivation is ensuring the very best care is delivered by the district nurses in the team I support.
I bring the care and compassion that lies at the heart of nursing to supporting the community of district nurses to provide the best care they can to patients and their families.
The district nurses should feel supported, valued and respected within the workforce. Access to appropriate training and pride in the standards of care given, are qualities that I am passionate about nurturing. I am also aware that staff need to feel empowered in their decision-making, and also need to be confident that I will support them where issues arise.
When I first took up the role of Clinical Nurse Coordinator for OOH DN, a review of the service was planned to change the way it was organised in order to meet the future needs of the patients in Ayrshire.
Some of the things I included when planning the new way of working was to introduce flexible rotational shift patterns in order to provide an improved service across the whole of Ayrshire. The idea was that response times to requests for calls from patients and families would be timelier to reduce the risk of patients waiting long periods of time to receive a visit from the OOH DN service, as these shift patterns overlap traditional ‘handover’ times.
As district nursing embraces, more and more interventions which were not traditionally carried out in the community setting, for example, chemotherapy pump disconnections or PEG tube care and insertion, staff require increased education and support to meet the needs of the local community; and also to contribute to reducing avoidable hospital admissions. As a leader of the team, it is important that I ensure this support and education is available to everyone.
My issue for development over the course of the Queen’s Nurse programme is concerned with strengthening and enhancing care delivered to people with (Chronic Obstructive Pulmonary Disease) COPD by district nurses. I met with the clinical team lead from a part of Ayrshire that has a high prevalence of COPD because it was a mining community and we decided we would look at if there was something we could do in the out of hours period that would prevent people having avoidable admissions.
I have initiated a working group and it involves the OOH DN service working closely with the day time service using technology enabled care in conjunction with telephone contact and home visits by the in-hours and OOH teams. We hope the patients will grow in confidence to self-manage their condition and be aware the district nurse is always available if needed. The aim is to promote more targeted and anticipatory care while preventing unscheduled admission to hospital and support the patients and their families within their home environment.